Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Palpation of pedal pulses was compared to noninvasive testing in 100 patients referred to a vascular laboratory. Subjects were 65 +/- 13 (mean +/- s.d.) years old. The right dorsalis pedis (DP) artery served as the reference artery for comparison of Doppler studies with physical examination of the pulses. Absolute Doppler pressures in the right DP were 129 +/- 50 mm Hg. The right ankle:brachial index (ABI) was 0.86 +/- 0.32. There were significant differences in ABI in those with (0.68 +/- 0.28) vs without (0.95 +/- 0.31) claudication in either extremity (p < 0.001). Rest pain was also associated with lower ABI (P < 0.04). Diabetics, hypertensives, claudicants and those with ischemic rest pain were less likely to have palpable pulses (P < 0.035). With right DP pressure >/= 118 mm Hg, 63 per cent of subjects had a palpable DP pulse, whereas 68 per cent with ABI > 0.82 had a palpable right DP. Of those (n = 35) with a right DP pressure < 118 mm Hg, only 6 per cent (n = 2) had a palpable pulse, whereas 5 per cent (2/40) with ABI </= 0.82 had palpable DP pulses. Based on these findings, it was predicted that a pulse would likely not be palpable in the left DP with a pressure < 118 mm Hg or with AB </= 0.82. The prediction based on systolic ankle pressures was correct, with 66 per cent sensitivity and 91 per cent specificity. The predication that a left DP pulse would not be palpable with AB </= 0.82 was more accurate (78% sensitive, 97% specific). Presence of a palpable DP pulse suggests the presence of a Doppler pressure >/= 188 mm Hg and ABI > 0.82. The range of ankle pressures with palpable right DP pulses was 64-220 mm Hg, whereas the range with nonpalpable DP was 42-300 mm Hg. Given the frequent disparity of pulse exam and ankle pressures, noninvasive Doppler testing may be necessary for many patients to accurately assess the vascular status of the leg.
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PMID:Assessment of noninvasive lower extremity arterial testing versus pulse exam. 860 Aug 56

A total of 114 patients with critical lower limb ischemia from 11 hospitals were randomized to either Pentoxifylline 600 mg or placebo given intravenously twice a day. Rest pain was evaluated both by the investigator and the patient. Pain was evaluated with the patient in the supine as well as in the sitting position using a pain score scale, a pain relief scale and a visual analogue scale. All patients underwent a clinical examination, measurement of ankle systolic blood pressure and arteriography. These arteriograms were evaluated by a radiologist who did not know which treatment had been given. If no beneficial effect of the treatment was observed after one week, further medication was discontinued. Otherwise the treatment continued for two additional weeks. There was no statistically significant difference in pain-free or absolute walking distance between the two groups. Evaluating the patients with the most pronounced amelioration of rest pain in the supine position (divided by 4 to divided by 2 points), there was a beneficial effect of Pentoxifylline compared to placebo. Evaluation of the total material did not, however, show any statistical significances between the groups. From further subgroup analysis excluding patients who had only slight pain at the entrance of the study, there was a significant improvement in rest pain in favour of Pentoxifylline following seven days of treatment. In this group the pain evaluated according to this visual analogue scale had decreased 37 points (54%) compared to 14 points (25%) in the placebo group. More side effects, mainly gastrointestinal, were observed in the Pentoxifylline group. Most of these could be eliminated by increasing the infusion time. Further investigations are necessary to evaluated the place of Pentoxifylline in the treatment of patients with critical limb ischemia.
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PMID:Efficacy and clinical tolerance of parenteral pentoxifylline in the treatment of critical lower limb ischemia. A placebo controlled multicenter study. Norwegian Pentoxifylline Multicenter Trial Group. 873 41

We have compared severely obese patients (body mass index > 35 kg m-2) undergoing laparoscopic or open gastroplasty (n = 15 in each group) to determine if laparoscopy results in any benefit in the obese. Postoperative pain, measured on a 100-mm visual analogue scale, and opioid consumption were recorded during the first two days after operation. Tests of pulmonary function were performed and SpO2 was measured 4 h after surgery and on days 1, 2 and 3 after operation. Pain at rest was similar in the two groups, but in the laparoscopy group, requirements for postoperative opioid were 50% less (P < 0.05). Pain intensity during mobilization and on coughing was significantly less after laparoscopy (differences between mean pain scores in both groups ranged from 20 to 32 mm during mobilization and from 32 to 34 mm during coughing). Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were reduced significantly less after laparoscopic gastroplasty than after open gastroplasty (on day 1 forced vital capacity was reduced by 50% compared with 64%, forced expiratory volume in 1 s was reduced by 50% compared with 66% and peak expiratory flow rate by 45% compared with 60%). SpO2 values were significantly greater in the laparoscopy group (day 1: mean 95 (SD 2)% vs 91 (5)%; day 3: 97 (1)% vs 94 (3)%). This study suggests that the beneficial effects observed after laparoscopic gastroplasty in morbidly obese patients were similar to those reported after laparoscopic cholecystectomy in non-obese patients.
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PMID:Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients. 962 24

We studied which device is most useful to reduce postoperative sore-throat. We investigated the relationship between intracuff pressure and postoperative sore-throat in using endotracheal intubation (ET), the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA) in adult patients. We classified sore-throat into categories; pain at rest, hoarseness and dysphasia. We evaluated pain at rest by the score (0: no pain, 1: mild discomfort, 2: mild pain, 3: severe pain). Pain at rest (scores 1, 2, 3) was complained by 10 patients in ET group, 3 in LMA group, 5 in COPA group on the day of operation, showing significantly lower incidence of pain at rest in LMA group than in ET group. Hoarseness was complained by 15 patients in ET group, 2 in LMA group and 4 in COPA group, showing significantly lower incidence of hoarseness in LMA and COPA groups than in ET group. Dysphasia was complained by 3 in ET group, 1 in LMA group and 2 in COPA group, showing no significant difference. These results suggest that LMA is most appropriate to reduce postoperative sore-throat.
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PMID:[Postoperative sore throat and intracuff pressure: comparison among endotracheal intubation, laryngeal mask airway and cuffed oropharyngeal airway]. 1065 13

In this prospective pilot study, nine patients suffering from complex regional pain syndrome of the arm were treated with morphine 0.16 mg h-1 (3.84 mg day-1) applied continuously through an axillary brachial plexus catheter. In all of them an oral analgesic medication including the less potent opioid tramadol had not provided sufficient pain relief. During regional treatment, patients were kept in hospital and physiotherapy was carried out frequently in order to improve strength and function of the affected arm. Pain at rest and during movement as well as grip strength were assessed at first visit, during morphine infusion and at a long-term follow-up visit. All assessments improved significantly during plexus analgesia. There were no major opioid related side-effects. The results from this pilot study indicate that continuous axillary brachial plexus analgesia with low dose morphine might be beneficial in patients suffering from complex regional pain syndrome of the arm.
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PMID:Continuous axillary brachial plexus analgesia with low dose morphine in patients with complex regional pain syndromes. 1075 69

Opioids are increasingly used in the treatment of chronic non-malignant pain. The aim of this open-label, randomised, parallel group study was to compare analgesia and side-effects of two commonly used opioid analgesics, tramadol and dihydrocodeine, in long-acting formulations in 60 osteoarthritis patients with strong pain despite NSAID's. Dose titration based on effect was performed with the respective immediate release solutions given additionally to tramadol 100 mg bid and dihydrocodeine 60 mg bid during the first 4 days of the 1 month treatment. Electrical sensation and pain thresholds over the osteoarthritic joint and at a distant location and gastrointestinal transit times were performed before and during treatment. Thirty patients with pain controlled by NSAID's alone formed the comparator group. Pain intensities at rest and during movement decreased highly significantly with tramadol and dihydrocodeine from median pre-treatment verbal ratings of over 3 (0=none, 4=unbearable) to 1 and below from the second treatment day onwards (ANOVA P<0.0001). Pain at rest was significantly lower with tramadol (ANOVA P=0.04), but ratings were similar during movement. Mean (95% CI) daily doses on days 1 and 28 were 209 (198-220) mg and 203 (191-206) mg of tramadol, and 129 (122-136) mg and 130 (121-134) mg of dihydrocodeine, respectively. Minor side-effects were more common with tramadol (P=0.04). Changes in bowel functions and symptoms were minor with both treatments, but the frequency of defaecation was lower and stools were harder with dihydrocodeine. Orocaecal transit time remained unchanged and similar to controls with both analgesics. Colonic transit times only increased significantly during treatment with dihydrocodeine. Sensation and pain thresholds were lower pre-treatment in both groups than in controls and increased during treatment. These antinociceptive effects were more marked in the tramadol group and distant from the osteoarthritic joint. We conclude rapid pain relief was achieved with both long-acting tramadol and dihydrocodeine with NSAID's in strong osteoarthritis pain. Minimal dose titration was required and side-effects were minor. Tramadol interfered less with intestinal function and showed greater antinociceptive action.
Pain 2001 Mar
PMID:Treatment of severe pain from osteoarthritis with slow-release tramadol or dihydrocodeine in combination with NSAID's: a randomised study comparing analgesia, antinociception and gastrointestinal effects. 1124 75

In a double blind study we have investigated the effects of epidural local anaesthesia (LA), when added to general anaesthesia (GA) and postoperative paracetamol and NSAID, on postoperative pain and gastrointestinal function in patients undergoing open hysterectomy. Sixty patients were randomized into three study groups: GA, and postoperative paracetamol and NSAID (GA, n=20); GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural saline (Saline, n=20); or GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural bupivacaine (Bupi, n=20). Patients were observed for 72 h postoperatively. Pain at rest, during cough, and mobilization, request for supplementary morphine, and time to first postoperative flatus, was reduced in patients receiving 24-h postoperative epidural anaesthesia, compared with the two other groups. However, these effects of epidural LA, were not sustained beyond the period of infusion, and no differences in PONV, time to first postoperative defecation, mobilization or time to discharge from hospital were observed between groups. A 24 h postoperative epidural infusion with bupivacaine, when added to postoperative paracetamol and NSAID, reduces pain and opioid requirements, but has only limited effects on gastrointestinal function and patient recovery.
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PMID:Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy. 1187 27

Pain relief for patients with osteoporosis is important to maintain mobility and facilitate physical therapy. Transdermal fentanyl may be useful but has not been studied systematically. Patients with at least one osteoporotic vertebral fracture requiring strong opioids were enrolled and received transdermal fentanyl. Treatment history, pain, ease of physical therapy, and quality of life were recorded at baseline and after 4 weeks. Of 64 patients enrolled, 49 completed the study; 12 withdrew because of adverse events, most commonly nausea, vomiting, or dizziness. Pain at rest and on movement decreased significantly from baseline to final assessment (mean scores 7.84 and 8.55, respectively, at baseline, falling to 3.56 and 4.50 after 4 weeks). Quality of life improved significantly, and 61% of patients were satisfied with the treatment. Ability to undergo physical therapy improved significantly. Transdermal fentanyl is useful for the treatment of severe back pain caused by osteoporosis.
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PMID:Transdermal fentanyl for the treatment of back pain caused by vertebral osteoporosis. 1221 66

Approximately 10% of people age >55 years have asymptomatic peripheral atherosclerotic disease (PAD), 5% have intermittent claudication (IC, the cardinal symptom), and 1% critical leg ischemia (rest pain or gangrene). In patients with IC, worsening occurs in approximately 16%, bypass surgery is required in approximately 7%, and amputation in approximately 4%. Disease progresses more frequently in diabetics and in tobacco smokers. Patients with PAD suffer increased cardiovascular morbidity related mainly to coronary artery disease with a mortality rate of approximately 30% after 5 years. Compared to patients without PAD, the relative risk of coronary death is approximately 6.6, overall cardiovascular mortality 5.9, and all-cause mortality 3.1. Pain at rest or ischemic gangrene indicates severe, often multilevel arterial occlusive disease and calls for aggressive management, which usually includes angiography and revascularization by percutaneous angioplasty or surgery. Critical limb ischemia results in some 150,000 amputations annually in the U.S., with perioperative mortality rates of 5-10% for below-knee and up to 50% for above-knee amputation because of comorbidities. Physical findings include trophic signs of ischemia, vascular bruits and peripheral pulse deficits. Ischemic ulcers usually involve the tips of the toes or the heel of the foot, and are typically painful on elevation and most bothersome at night. Ancillary diagnostic modalities begin with the ankle/arm systolic pressure index (ABI); a value <0.90 indicates PAD with significant prognostic implications. More precise assessment in the noninvasive vascular laboratory may involve a combination of segmental limb pressure measurements and pulse volume waveform recording, which is over 90% accurate for predicting the level and extent of PAD. Exercise testing enhances the value of these observations. Magnetic resonance imaging methods are emerging to characterize the arterial wall and atherosclerotic lesions. The diagnosis of PAD does not generally require invasive techniques, and most patients with IC do not need contrast angiography. Angiography is indicated for mapping of the extent and location of arterial pathology prior to revascularization.
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PMID:Evaluation of patients with peripheral vascular disease. 1235 43

We sought to investigate the safety and efficacy of intramuscular gene therapy with vascular endothelial growth factor (VEGF) in patients with chronic critical leg ischemia.Gene transfer was performed in 24 limbs of 21 patients with rest pain, some of whom also had nonhealing ischemic ulcers (n = 16) due to occlusive peripheral arterial disease. Between 400 microg and 2000 microg of phVEGF(165) (400 microg, n = 2; 800 microg, n = 4; 1200 microg, n = 4; 1600 microg, n = 6; and 2000 microg, n = 8) was injected directly into the muscles of the ischemic limb; the same dose was injected 4 weeks later. The ratio of blood pressures at the ankle and brachial artery was measured before and after treatment. Mean (+/- SD) plasma levels of VEGF increased significantly from 26 +/- 31 pg/mL to 63 +/- 56 pg/mL (P <0.005), and the ankle-brachial index improved significantly from 0.58 +/- 0.24 to 0.72 +/- 0.28 (P <0.001). Magnetic resonance angiography showed qualitative evidence of improved distal flow in 19 limbs (79%). Ischemic ulcers healed or improved markedly in 12 limbs (75%). Rest pain was relieved or improved markedly in 20 limbs (83%). Amputation was performed in two limbs because of wound infection. Complications were limited to transient leg edema in six limbs. Intramuscular gene therapy with VEGF(165) for patients with chronic critical leg ischemia is safe, feasible, and effective.
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PMID:Intramuscular vascular endothelial growth factor gene therapy in patients with chronic critical leg ischemia. 1258 39


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